What EHRs And Marriage Have In Common

IT needs to understand the logistical hurdles and the emotional ones for clinicians--and realize an EHR rollout is just the beginning of a long-term partnership.

I once worked with a person at a major media company, let's call him Mac. Mac was smart and conscientious, but whenever the IT department introduced a new application on our desktops, he would freak out.

Despite the fact that we were given detailed, in-person training and follow-up tech support, Mac was constantly on the phone asking for more help, constantly complaining about how hard the program was to use. I'm sure you know many clinicians like that. Their resistance to a new electronic health record (EHR) system is almost palpable.

How do you overcome this resistance, especially when the EHR you just installed disrupts their work routine? Challenges like this have to be approached with a two-pronged strategy. Call it the "psychotechnical" approach.

You first need to understand any legitimate logistical problems they face as they work with the new health IT (HIT) system. But you also want to address any emotional roadblocks to adapting the new program, what experts sometimes refer to as the psychology of resistance.

Zeroing In On Physicians' Woes

Dr. Carolyn Clancey, director of the Agency of Healthcare Research and Quality, summed up the logistics issue succinctly: "The main challenges are not technical; it's more about integrating HIT with workflow, making it work for patients and clinicians who don't necessarily think like the computer guys do."

A recent Healthcare Information and Management Systems Society survey confirms that many clinicians are in fact feeling the pain as they put EHRs in place. While most respondents said they're satisfied with their EHR, they list workflow problems as their No. 1 usability pain point, with 84% complaining about it. Among their specific concerns:

-- They need to view many different areas in the EHR to capture the patient's story.

-- The system identifies the same thing by different names.

The list goes on and on. What's the best way to address such concerns?

Dr. Marvin Harper, chief medical information officer at Children's Hospital Boston, notes that the complaint about confusing nomenclature is legitimate but not strictly speaking an EHR issue. "During our EHR implementation, it took months to get multidisciplinary groups to agree on common terminology--which did not exist with paper documentation," Dr. Harper told me in an email. Once accomplished, "this has helped tremendously in caring for patients," he said.

Dr. Dan Nigrin, senior VP for information services and CIO of the Boston hospital's division of endocrinology & informatics program, recommends a balanced approach when dealing with the clinical team. "We need to tweak the software so that it fits the clinician workflow better," Dr. Nigrin told me, "but also convince clinicians to adapt and change where possible. You definitely don't want to upset an established clinical workflow. It's that way for good reason ... But on the other hand, there are plenty of things in medicine that are done in certain ways simply because 'that's the way we've always done them.'"

Dr. Nigrin says it's critical to get clinicians involved in the EHR implementation teams. When clinicians understand that a new workflow can make their lives easier, they're usually willing to change. "But it's also important for those same clinicians to put their foot down every now and then when they see a potential change in process that could lead to patient harm, and to insist instead that the software be adapted," he said.